182 research outputs found
Mapping urban physical distancing constraints, sub-Saharan Africa : a case study from Kenya
No full textWith the onset of the coronavirus disease 2019 (COVID-19) pandemic, public health measures such as physical distancing were recommended to reduce transmission of the virus causing the disease. However, the same approach in all areas, regardless of context, may lead to measures being of limited effectiveness and having unforeseen negative consequences, such as loss of livelihoods and food insecurity. A prerequisite to planning and implementing effective, context-appropriate measures to slow community transmission is an understanding of any constraints, such as the locations where physical distancing would not be possible. Focusing on sub-Saharan Africa, we outline and discuss challenges that are faced by residents of urban informal settlements in the ongoing COVID-19 pandemic. We describe how new geospatial data sets can be integrated to provide more detailed information about local constraints on physical distancing and can inform planning of alternative ways to reduce transmission of COVID-19 between people. We include a case study for Nairobi County, Kenya, with mapped outputs which illustrate the intra-urban variation in the feasibility of physical distancing and the expected difficulty for residents of many informal settlement areas. Our examples demonstrate the potential of new geospatial data sets to provide insights and support to policy-making for public health measures, including COVID-19
Access to emergency hospital care provided by the public sector in sub-Saharan Africa in 2015: a geocoded inventory and spatial analysis
No full textBackgroundTimely access to emergency care can substantially reduce mortality. International benchmarks for access to emergency hospital care have been established to guide ambitions for universal health care by 2030. However, no Pan-African database of where hospitals are located exists; therefore, we aimed to complete a geocoded inventory of hospital services in Africa in relation to how populations might access these services in 2015, with focus on women of child bearing age.MethodsWe assembled a geocoded inventory of public hospitals across 48 countries and islands of sub-Saharan Africa, including Zanzibar, using data from various sources. We only included public hospitals with emergency services that were managed by governments at national or local levels and faith-based or non-governmental organisations. For hospital listings without geographical coordinates, we geocoded each facility using Microsoft Encarta (version 2009), Google Earth (version 7.3), Geonames, Fallingrain, OpenStreetMap, and other national digital gazetteers. We obtained estimates for total population and women of child bearing age (15–49 years) at a 1 km2 spatial resolution from the WorldPop database for 2015. Additionally, we assembled road network data from Google Map Maker Project and OpenStreetMap using ArcMap (version 10.5). We then combined the road network and the population locations to form a travel impedance surface. Subsequently, we formulated a cost distance algorithm based on the location of public hospitals and the travel impedance surface in AccessMod (version 5) to compute the proportion of populations living within a combined walking and motorised travel time of 2 h to emergency hospital services.FindingsWe consulted 100 databases from 48 sub-Saharan countries and islands, including Zanzibar, and identified 4908 public hospitals. 2701 hospitals had either full or partial information about their geographical coordinates. We estimated that 287 282 013 (29·0%) people and 64 495 526 (28·2%) women of child bearing age are located more than 2-h travel time from the nearest hospital. Marked differences were observed within and between countries, ranging from less than 25% of the population within 2-h travel time of a public hospital in South Sudan to more than 90% in Nigeria, Kenya, Cape Verde, Swaziland, South Africa, Burundi, Comoros, São Tomé and Príncipe, and Zanzibar. Only 16 countries reached the international benchmark of more than 80% of their populations living within a 2-h travel time of the nearest hospital.InterpretationPhysical access to emergency hospital care provided by the public sector in Africa remains poor and varies substantially within and between countries. Innovative targeting of emergency care services is necessary to reduce these inequities. This study provides the first spatial census of public hospital services in Africa.FundingWellcome Trust and the UK Department for International Development
A spatial database of health facilities managed by the public health sector in sub Saharan Africa
No full textHealth facilities form a central component of health systems, providing curative and preventative services and structured to allow referral through a pyramid of increasingly complex service provision. Access to health care is a complex and multidimensional concept, however, in its most narrow sense, it refers to geographic availability. Linking health facilities to populations has been a traditional per capita index of heath care coverage, however, with locations of health facilities and higher resolution population data, Geographic Information Systems allow for a more refined metric of health access, define geographic inequalities in service provision and inform planning. Maximizing the value of spatial heath access requires a complete census of providers and their locations. To-date there has not been a single, geo-referenced and comprehensive public health facility database for sub-Saharan Africa. We have assembled national master health facility lists from a variety of government and non-government sources from 50 countries and islands in sub Saharan Africa and used multiple geocoding methods to provide a comprehensive spatial inventory of 98,745 public health facilities.</p
Naar een geïntegreerde gebiedsgerichte ontwikkelingsbenadering voor de metropolitane regio van Nairobi: Analyses van lokale gemeenschapsgebaseerde organisaties en hun ontwikkelingsstrategieën tegen sociale en ruimtelijke polarisatie
No full textThe PhD research examines social and spatial polarisation in the context of one of Kenyas rapidly urbanising areas: the Nairobi Region. Its overall objective is to analyse how the states development strategies are reinforcing socio-spatial polarisation in the Nairobi Region and also how communities through their community-based organisations are countering urban and regional socio-spatial polarisation. In addition, it focuses on the institutions that govern the actions of the ensemble of actors in the Region, and considers the socio-political as well as spatial relations of the capitalist and non-capitalist forms of economicdevelopment in Nairobis urban core and in the neighbouring southern Kajiado County. Furthermore, it employs an integrated analytical approach to study these inter-related aspects of socio-spatial polarisation. To research socio-spatial polarisation and the transformation which isrealised through the agency of the communities, a theoretical approach has been adopted that links the theory of Africas moral economy/the economy of affection, with the regulationist theory perspective on uneven development and the social innovation theorys perspective on spatial development within an integrated analytical framework. Since African societies display a combination of both capitalist as well as non-capitalist social relations, the research necessitated the adoption of an integratedconceptual approach that incorporates both types of relations. Furthermore, each theory complements the other theories and therefore enriches the overall framework through the analytical tools each provides. The economy of affection conceptualises the non-capitalist relations (indigenous and informal institutions) in African societies from a moral economy perspective, while the regulation approach provides a political economy perspective derived from neo-Marxism which focuses on the dynamics of accumulation and regulation in capitalist societies (formal and informal institutions). The regulationist perspective on uneven regional development draws on the concept of path-dependency to explain how a regions development is significantly dependent on past development strategies. Ultimately, the social innovation perspective on spatial development links the satisfaction of human needs in regions and urban areas, to innovation in the social relationships of governance as they are embedded in the urban area and in the region. The PhD consists of a collection of papers for publication. The first paper, Towards an Enriched Regulationist Perspective of Polarisation in Kenya - The Case of Nairobi combines three approaches deriving from Marxian perspectives, specifically the regulation school, uneven geographical development and Africas economy ofaffection. The combined theoretical perspective is used to empirically examine Kenyas uneven spatial development and the maintenance of inequality, characterised by an indigenous capitalist group and a middle classgroup on the one hand and informal urban labourers on the other. The second paper is a monograph titled Building Inclusive Post-colonial UrbanDynamics in a Context of Informalisation: The Case of Commercial Activities in Nairobis Eastleigh Neighbourhood. It considers the urban context of Nairobis Eastleigh commercial centre in which two urban communities are analysed: i.e. the Somali entrepreneurial and the Non-Somali informal street vending communities. The analysis examines the methods used by the Somali entrepreneurial community for economic empowerment resulting in the social and spatial transformation of Eastleigh neighbourhood. Additionally, it examines the methods used by the non-Somali street vending community in their contestations for access to trading space in Eastleighs commercial centre. The third paper on An Integrated Area Development Strategy for Empowering Communities in Kajiado - Nairobis Southern Metropolitan Region, analyses the specific nature of Kajiados unevendevelopment. The paper combines Africas economy of affection concept, with the regulationist perspective on uneven development, and the socialinnovation perspective on spatial development. The combined theoreticalperspective is used to analyse the social and spatial processes that are enhancing or obstructing the Maasai communitys capacity for empoweredaction to counter the fragmentation arising from conflicting land-use rationalities in Kajiado. The PhD research finds that the highly uneven social and spatial structures which were established through the introduction of capitalist development during Kenyas colonial period have been reproduced in post-colonial Kenya. The research further finds that the emerging empowerment processes being put in place by both the regionaland urban communities through their community-based organisations are geared towards the transformation of governance relations in Nairobis urban and regional development. Consequently, the research argues that Nairobi is in need of a new, urban and regional development framework whichis integrated and also bottom-linked. The relevance of this approach isnot only limited to its ability to provide insights into processes thatmay facilitate the satisfaction of unmet needs; but also includes its ability to provide insights into processes that enhance the development of inclusive governance dynamics between Nairobis diverse urban and regional communities and key development actors.status: Publishe
Differences between gridded population data impact measures of geographic access to healthcare in sub-Saharan Africa
No full textAccess to health care is imperative to health equity and well-being. Geographic access to health care can be modelled by combining different spatial datasets, among others, on the distribution of existing health facilities and populations. Several population datasets are currently available, but their impact on accessibility analyses is unknown. In this study, we model the geographic accessibility of public health facilities at 100-meter resolution in sub-Saharan Africa and explore the effect of six among the most popular gridded population datasets on coverage statistics at different administrative levels. We found differences in accessibility coverage of more than 70% at the sub-national level, based on a one-hour travel time threshold. Differences are significant in large and sparsely populated administrative units, dramatically shaping patterns of health care accessibility at the national and sub-national level. The results underscore an essential source of uncertainty in accessibility analyses that should be systematically assessed in policy-making
Author Correction: Advancing the frontiers of geographic accessibility to healthcare services
No full textGlomus tumor presenting as complex regional pain syndrome of the left upper limb: a case report
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Application of GIS in Public Health Practice: A Consortium’s Approach to Tackling Travel Delays in Obstetric Emergencies in Urban Areas (Short Paper)
No full textGeographic Information System (GIS) has become an effective and reliable tool for researchers, policymakers, and decision-makers to map health outcomes and inform targeted planning, evaluation, and monitoring. With the advent of big data-enabled GIS, researchers can now identify disparities and spatial inequalities in health at more granular levels, enabling them to provide more accurate and robust services and products for healthcare. This paper aims to showcase the progress of the On Tackling In-transit Delays for Mothers in Emergency (OnTIME) project, which is a unique collaborative effort between academia, policymakers, and industrial partners. The paper demonstrates how the limitations of traditional spatial accessibility models and data gaps have been overcome by combining GIS and big data to map the geographic accessibility and coverage of health facilities capable of providing emergency obstetric care (EmOC) in conurbations in Africa. The OnTIME project employs various GIS technologies and concepts, such as big spatial data, spatial databases, and public participation geographic information systems (PPGIS). We provide an overview of these concepts in relation to the OnTIME project to demonstrate the application of GIS in public health practice
Modelling geographical accessibility to urban centres in Kenya in 2019
No full textBackground
Access to major services, often located in urban centres, is key to the realisation of numerous Sustainable Development Goals (SDGs). In Kenya, there are no up-to-date and localised estimates of spatial access to urban centres. We estimate the travel time to urban centres and identify marginalised populations for prioritisation and targeting.
Methods
Urban centres were mapped from the 2019 Kenya population census and combined with spatial databases of road networks, elevation, land use and travel barriers within a cost-friction algorithm to compute travel time. Seven travel scenarios were considered: i) walking only (least optimistic), ii) bicycle only, iii) motorcycle only, iv) vehicle only (most optimistic), v) walking followed by motorcycle transport, vi) walking followed by vehicle transport, and vii) walking followed by motorcycle and then vehicle transport (most pragmatic). Mean travel time, and proportion of the population within 1-hour and 2-hours of the urban centres were summarized at sub-national units (counties) used for devolved planning. Inequities were explored and correlations between the proportion of the population within 1-hour of an urban centre and ten SDG indicators were computed.
Results
A total of 307 urban centres were digitised. Nationally, the mean travel time was 4.5-hours for the walking-only scenario, 1.0-hours for the vehicle only (most optimistic) scenario and 1.5-hours for the walking-motorcycle-vehicle (most pragmatic) scenario. Forty-five per cent (21.3 million people) and 87% (41.6 million people) of Kenya’s population resided within 1-hour of the nearest urban centre for the least optimistic and most pragmatic scenarios respectively. Over 3.2 million people were considered marginalised or living outside the 2-hour threshold in the pragmatic scenario, 16.0 million Kenyans for walking only, and 2.2 million for the most optimistic scenario. County-level spatial access was highly heterogeneous ranging between 8%-100% and 32%-100% of people within the 1-hour threshold for the least and most optimistic scenarios, respectively. Counties in northern and eastern parts of Kenya were generally most marginalised. The correlation coefficients for nine SDG indicators ranged between 0.45 to 0.78 and were statistically significant.
Conclusion
Travel time to urban centres in Kenya is heterogeneous. Therefore, marginalised populations should be prioritised during resource allocation and policies should be formulated to enhance equitable access to public services and opportunities in urban areas
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